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BACKGROUND: Evidence from developed countries has shown that abortion-related mortality and morbidity has decreased with the liberalization of the abortion law. This study aimed to assess the trend of hospital-based abortion complications during the transition of legalization in Ethiopia in May 2005. METHODS: Medical records of women with abortion complications from 2003 to 2007 were reviewed (n = 773). Abortion and its complications with regard to legalization were described by rates and ratios, and predictors of fatal outcomes were analyzed by logistic regression. RESULTS: The overall and abortion-related maternal mortality ratios (AMMRs) showed a Non-statistically significant downward trend over the 5-year period. However, the case fatality rate of abortion increased from 1.1% in 2003 to 3.6% in 2007. Late gestational age, history of interference and presenting after new abortion legislation passed have been found to be significant predictors of mortality. CONCLUSION: Decreased trends of abortion ratio and the AMMR were identified, but the severity of abortion complications and the case fatality rate increased during the transition of legal revision.

It is ten years this month since the Choice on Termination of Pregnancy (CTOP) Act of 1996 was enacted. The passing of this Act was in keeping with the South African Constitution and represented a major breakthrough for women's reproductive rights. The Act allows for abortion on request to be performed at a designated health facility. This may be performed by a doctor or, during the first trimester, by a registered midwife who has completed the prescribed training course. In the second trimester, abortions may be performed by doctors up to 20 weeks' gestational age. This applies if the pregnancy endangers a woman's physical or mental health, if there is a risk of fetal abnormality, in the case of rape or incest, or if the continued pregnancy could adversely affect a woman's socio-economic situation. The Act has increased women's legal access to safe abortion services, leading to a dramatic decline in morbidity and mortality associated with unsafe abortions. However, numerous barriers continue to limit service access. One indicator of this is that almost a quarter of abortions are performed after 12 weeks of pregnancy. In addition, there is evidence that some women continue to have abortions outside of designated facilities.

To address the knowledge gap that exists in costing unsafe abortion in Ethiopia, estimates were derived of the cost to the health system of providing post-abortion care (PAC), based on research conducted in 2008. Fourteen public and private health facilities were selected, representing 3 levels of health care. Cost information on drugs, supplies, material, personnel time, and out-of-pocket expenses was collected using an ingredients approach. Sensitivity analysis was used to determine the most likely range of costs. The average direct cost per client, across 5 types of abortion complications, was US $36.21. The annual direct cost nationally ranged from US $6.5 to US $8.9 million. Including indirect costs and satisfying all demand increased the annual national cost to US $47 million. PAC consumes a large portion of the total expenditure in reproductive health in Ethiopia. Investing more resources in family planning programs to prevent unwanted pregnancies would be cost-beneficial to the health system.

"OBJECTIVE: To implement the Safe Abortion Care (SAC) model in public health facilities in the Tigray region of Ethiopia and document the availability, utilization, and quality of SAC services over time. METHODS: The project oriented providers in 50 public health facilities in Tigray to the SAC model. Changes in SAC indicators between baseline and endline were assessed using a retrospective review of procedure logbooks at baseline and prospective monitoring of procedure logbooks for facility performance after introduction of the SAC model. RESULTS: Availability of SAC services increased from 39% to 86% of the recommended number of 5 facilities per 500000 population, primarily as a result of functional improvements at health centers. Decentralization was accompanied by a 94% increase in the annualized number of women who received services. The proportion of uterine evacuation procedures for induced abortion rose from 7% to 60% (P0.01), and the proportion performed with recommended technology increased from 30% to 85% (P0.01). The proportion of abortion patients who received modern contraception also increasedfrom 31% to 78% (P0.01). DISCUSSION: While widespread service delivery improvements were recorded using the SAC monitoring appoach, the project design was built around existing programmatic activities of the local health authority and reflects some related research limitations. For example, there was No comparison group of facilities, timing did Not allow for prospective collection of the baseline data before the intervention, and facilities received different levels of monitoring support. CONCLUSION: Using the SAC model, public health facilities tracked progress and made needed adjustments, which improved service delivery. Continued focus on critical safe abortion care elements should increase the availability, quality, and use of life-saving are to reduce preventable abortion mortality in the region."

Complications of an unsafe abortion are a major contributor to maternal deaths and morbidity in Africa. When abortions are performed in safe environments, such complications are almost all preventable. This paper reports results from a nationally representative health facility study conducted in Ethiopia in 2008. The safe abortion care (SAC) model, a monitoring approach to assess the amount, distribution, use and quality of abortion services, provided a framework. Data collection included key informant interviews with 335 health care providers, prospective data on 8911 women seeking treatment for abortion complications or induced abortion and review of facility logbooks. Although the existing hospitals perform most basic abortion care functions, the number of facilities providing basic and comprehensive abortion care for the population size fell far short of the recommended levels. Almost one-half (48%) of women treated for obstetric complications in the facilities had abortion complications. The use of appropriate abortion technologies in the first trimester and the provision of post-abortion contraception overall were reasonably strong, especially in private sector facilities. Following abortion law reform in 2005 and subsequent service expansion and improvements, Ethiopia remains committed to reducing complications from an unsafe abortion. This study provides the first national snapshot to measure changes in a dynamic abortion care environment.

The high demand for abortion related services in Addis Ababa, Ethiopia indicates a reliance on abortion to control fertility and highlights an opportunity to increase access to contraceptives and improve post-abortion care. We analyzed the medical records of 1,200 women seeking abortion related services. Logistic regression was used to determine factors associated with use of modern or long-acting contraceptive post-abortion. Multivariate results illustrate that women aged 40-44, students, employed women, receipt of services in private clinics, number of children, and number of previous abortions were significantly associated with the odds of adopting any modern contraceptive post-abortion. The odds of choosing a long-active contraceptive method were significantly and positively associated with being age 25-29, attaining secondary or higher education, and number of children. Improved services and information along with reliable access to modern and long-acting contraceptives can reduce the need to use abortion to control fertility among women in Addis

BACKGROUND: In 2005 Ethiopia took the important step to protect women's reproductive health by liberalizing the abortion law. As a result women were given access to safe pregnancy termination in first and second trimester. This study aims to describe socio-economic characteristics and contraceptive experience among women seeking abortion in Jimma, Ethiopia and to describe determinants of second trimester abortion. METHODS: A cross-sectional study conducted October 2011 - April 2012 in Jimma Town, Ethiopia among women having safely induced abortion and women having unsafely induced abortion. In all 808 safe abortion cases and 21 unsafe abortion cases were included in the study. Of the 829 abortions, 729 were first trimester and 100 were second trimester abortions. Bivariate and multivariate logistic regressions were used to determine risk factors associated with second trimester abortion. The associations are presented as odds ratios (OR) with 95% confidential intervals. Age stratified analyses of contraceptive experience among women with first and second trimester abortions are also presented. RESULTS: Socio-economic characteristics associated with increased ORs of second trimester abortion were: age < 19 years, being single, widowed or divorced, attending school, being unemployment, being nullipara or para 3+, and having low education. The contraceptive prevalence rate varied across age groups and was particularly low among young girls and young women experiencing second trimester abortion where only 15% and 19% stated they had ever used contraception. CONCLUSION: Young age, poor education and the prospect of single parenthood were associated with second trimester abortion. Young girls and young women were using contraception comparatively less often than older women. To ensure women full right to control their fertility in the setting studied, modern contraception should be made available, accessible and affordable for all women, regardless of age.

"Limited access to modern contraceptives in populations that desire smaller families can lead to repeat unintended pregnancy and repeat abortions. We conducted an analysis of the medical records of 1,200 women seeking abortion-related services in public and private facilities in Addis Ababa, Ethiopia from October 2008 to February 2009. We examined the characteristics of initial and repeat abortion clients including prior contraceptive use and subsequent method selection. The incidence of repeat abortion was 30%. Compared with women seeking their first abortion, significantly more repeat abortion clients had ever used contraceptives and they were nearly twice as likely to leave the facility with a method. However, repeat abortion clients were significantly more likely to have ever used short-term reversible methods and to choose short-term methods post-abortion. Contraceptive counseling services for repeat abortion clients’ should address reasons for previous contraceptive failure, discontinuation, or non-use. Post-abortion family planning services should be strengthened to help decrease repeat abortion. "

"BACKGROUND: Although the common direct obstetric causes of maternal mortality are known from the literature, the contribution of each cause and the change in trend over decades is unknown in Ethiopia. The objective of this review was to assess the trend of proportion of maternal mortality due to the common direct causes. METHODS: This systematic review was done on eighteen health facility based maternal mortality studies conducted between 1980 and 2012 in Ethiopia. Emphasis was given to the proportion of maternal mortality due to direct causes and their case fatality rates. RESULTS: The summary of the findings has shown that the top four causes of maternal mortality in the year 1980-1999 were abortion related complications (31%), obstructed labor/uterine rupture (29%), sepsis/infection (21%) and hemorrhage (12%). In the last decade, however, the top four causes of maternal mortality were obstructed labor/uterine rupture (36%), hemorrhage (22%), hypertensive disorders of pregnancy (19%) and sepsis/infection (13%). CONCLUSION: Abortion and infection related maternal deaths have declined significantly in the last decade. Obstructed labor continues to be the major cause of maternal deaths; maternal deaths due to hypertensive disorders and hemorrhage showed an increasing trend. The findings in this review were somehow comparable with the WHO analysis for Africa in the same period with the exception of obstructed labor."

Background: Unsafe abortion is one of the leading causes of maternal mortality and morbidity worldwide accounting for 13% of maternal deaths globally. Objective: To assess quality and determinant factors of post-abortion care in governmental Hospitals of Tigray, Ethiopia. Method: Institution based Cross-sectional study was conducted from January to May 2013. Four hundred twenty post apportion care clients were interviewed and 60 clients were observed to obtain qualitative data. Data was collected using pre prepared structured checklist and analyzed using SPSS version 16.00. The association between dependent and in dependent variables was assessed and presented using descriptive statistics, and logistic regression. Results: Majority (46.9%) of the study subjects fall in to the age category of 14-19 years. The study depicted that only 40.6% of the clients were satisfied. Client satisfaction was significantly associated with educational and occupational status, laboratory prescription and toilet access. Only 48 % of study subjects were informed about the available family planning methods and supplied with. The observational study revealed that 88.3% of the clients did not get the opportunity to pose questions or concerns. Only one of the health institutions has functional sink with adequate water supply in the abortion room. No more than 22.2 % of the care providers got refresher training on relevant areas. Conclusion: This study has identified main concerns that could have great input on the improvement of post-abortion care. Hence, we can conclude that patient satisfaction is low and there is lack of refreshments trainings especially on counseling and supporting. Besides, there are shortage of materials and supplies. This all could have synergetic effect on compromising the quality of post-abortion care. For this reason, it is recommended to skill up the providers with evidence based trainings to enhance quality of post-abortion care.